Comprehensive ESRD Care Initiative

The Comprehensive ESRD Care initiative is designed to identify, test, and evaluate new ways to improve care for Medicare beneficiaries with End-Stage Renal Disease (ESRD). Through the Comprehensive ESRD Care initiative, CMS will partner with health care providers and suppliers to test the effectiveness of a new payment and service delivery model in providing beneficiaries with patient-centered, high-quality care.


Beneficiaries with ESRD have significant care needs. These beneficiaries constituted 1.3% of the Medicare population and accounted for an estimated 7.5% of Medicare spending, totaling over $20 billion in 2010. These high costs are often the result of underlying disease complications and multiple co-morbidities, which often lead to high rates of hospital admission and readmissions, as well as a mortality rate that is much higher than the general Medicare population. Because of these complex health needs, beneficiaries often require visits to multiple providers and follow multiple care plans, which can be challenging for beneficiaries if care is not coordinated. Through enhanced care coordination, these beneficiaries will have a more patient-centered care experience, which will ultimately, improve health outcomes.

Initiative Details

Through the Comprehensive ESRD Care initiative, CMS will partner with groups of health care providers and suppliers – ESRD Seamless Care Organizations (ESCOs) – to test and evaluate a new model of payment and care delivery specific to Medicare beneficiaries with ESRD. Participating ESCOs will be clinically and financially responsible for all care offered to a group of matched beneficiaries, not only dialysis care or care specifically related to a beneficiary’s ESRD.

CMS reopened the Request for Applications (RFA) for the Comprehensive ESRD Care initiative after consideration of stakeholder feedback and revision of the RFA. With this open application period, we were particularly interested in creating opportunities for small (non-large-dialysis organization, LDO) dialysis organizations to participate and making sure that the financial business case for all ESCOs is compelling enough to partner with CMS under the Comprehensive ESRD Care Initiative. The application period for large dialysis organizations and non-LDOs closed on June 23, 2014 and September 15, 2014 respectively. CMS is currently in the process of finalizing the selection of LDO and non-LDO participants in anticipation of the July 1, 2015 start date.

More information about the Comprehensive ESRD Care initiative and application process can be found in the revised Request for Application (PDF) updated on May 22, 2014.

Additional Information

Questions about the Comprehensive ESRD Care initiative application, or the initiative generally, can be sent to